UCSF unveils bold vision for new hospital, outpatient care, and translational research

UCSF leaders are recommending a bold plan to establish state-of-the-art, technologically advanced patient care facilities at three major sites as part of a long-term vision to advance UCSF’s education, research and health care missions.

The plan will be reviewed at two upcoming community information meetings in San
Francisco: Monday, September 27, 7:00 PM at UCSF Mission Bay, Genentech Hall, 600 16th Street, and Wednesday, September 29, at 7:00 PM at UCSF Millberry Conference Center, 500 Parnassus Avenue.

Its recommendations call for a combination of new buildings, renovated facilities, and expanded facilities at the UCSF Mission Bay, Parnassus, and Mount Zion campuses. The project would be carried out in phases over the next 15 years.  The key elements of the plan are:

* MISSION BAY—Development of integrated specialty hospitals, including UCSF Children’s Hospital, a UCSF Women’s Hospital and the first phase of a UCSF Cancer Hospital on the Mission Bay campus by 2013, together with outpatient facilities and new translational research facilities to speed the transfer of new medical knowledge to clinical practice. The number of beds in the first phase is expected to total about 210, with a possibility of expansion in later phases.

* PARNASSUS — Major investment in renovations to the 550-bed Moffitt/Long hospital buildings that constitute UCSF Medical Center at Parnassus Heights by 2013, followed by a new inpatient hospital pavilion with about 130 beds.

* MOUNT ZION—Expanded use of UCSF Mount Zion as an innovative campus for ambulatory care, outpatient surgery, and related clinical research and education.

The plan is designed to integrate superb patient care with the latest technology in a healing environment.  “These new facilities will provide effective, safe, affordable and equitable care for San Franciscans and others throughout the West,” said Mark Laret, chief executive officer of UCSF Medical Center. “They will be designed to meet clinical research and medical education needs and will be flexible enough to accommodate changes in technology, medical practice and education as well as increasing patient numbers.”

The recommendations, which represent four years of planning, were developed by the Chancellor’s Advisory Committee on the Long Range Development Plan (LRDP) Amendment.  The committee presented the recommendations to UCSF Chancellor J. Michael Bishop, who approved the plan for conveyance to the UC Board of Regents.  Presentation to the Regents for consideration is expected in early 2005.

“I am grateful to the many members of the campus and local community who joined in the searching deliberations that gave rise to the recommendations,” Bishop said.  “The plans have my strong support. They address the needs of our clinical enterprise in a thoughtful manner and lay the groundwork for a more effective integration of our clinical, teaching and research missions.”

While the impetus for the committee was to address UCSF clinical facilities in light of state seismic laws—which aim to protect hospitalized patients from harm in an earthquake—the planning process encompassed how UCSF could advance clinical, research and educational missions across all campus sites.

Craig Van Dyke, MD, chair of the Department of Psychiatry, served as chair of the LRDP Committee, and Bruce Spaulding, vice chancellor for University Advancement and Planning, served as committee vice chair.  CEO Laret and David Kessler, MD, dean of the UCSF School of Medicine and vice chancellor for medical affairs, led the planning process, in which five campus locations for hospital replacement were evaluated using detailed screening criteria. With input from the Academic Senate, faculty, staff, students, consultants, members of the public and the UCSF Community Advisory Group, a long-term vision for UCSF’s clinical and research programs emerged.

In announcing the recommendations, the UCSF leadership group emphasized that this is the beginning of a process that will involve work groups to do the detailed planning for individual campuses and programs.  It will include development of business plans, development of a master site plan for either the current Mission Bay campus or on newly acquired land, and review of plans in accordance with the California Environmental Quality Act, as well as approval by the UC Regents.  The plans are subject to further refinement as a result of these processes.

UCSF Medical Center is one of the highest ranked academic medical centers in the country, yet it is the smallest among its peers, the UCSF officials noted in a message to the UCSF community. “This new vision should allow us to grow to meet the increasing demand for our services, to support our excellent academic programs and to resolve our seismic and facilities issues,” they said.

Kessler emphasized that “UCSF is and will continue—under this plan—to be great across the board.  We have chosen to foster excellence at multiple locations because no one location is going to be able to do it all.  To advance the science and art of medicine, it is very important to have depth and integration of clinical, academic and research programs at each location. Each site will have a different emphasis, but each one will be great in its own way.”

Under the recommendations, UCSF will expand Mission Bay as a major center for health care and related clinical research in addition to the basic science research and teaching already being conducted there.

By integrating multiple specialty hospitals at Mission Bay, UCSF can accelerate its translational research—the “bench to bedside” collaboration among basic scientists, clinical researchers and physicians that is geared to increasing the pace at which laboratory discovery translates to improved patient care.  A faulty gene or the faulty protein it creates, for example, might be implicated in prostate cancer, and this knowledge can lead to identifying a new diagnostic technique or drug that either arrests or corrects the gene or protein’s malfunction. A key component of this process is testing the safety and effectiveness of new diagnostic strategies and experimental drugs. In the latter case, this requires studies first in animals and then in patients, in carefully controlled clinical trials.

At the Parnassus campus, UCSF is investing heavily in research and teaching programs at the frontiers of medicine, such as stem cell biology, genetics and emerging diseases.  The ability to transfer the results of basic biomedical research and the intellectual capital of faculty, staff, and students into benefits for patients—in real time—is the hallmark of an academic medical center, where the “hard to diagnose” and “difficult to treat” patients come for care every day.

Planning is ongoing at Parnassus to upgrade facilities and to develop additional space vacated by faculty and staff moves to Mission Bay. Expenditures for renovation and expansion in the past decade and over the next five years at Parnassus Heights nearly equal the $820 million cost to build the first phase of the teaching and research campus at Mission Bay, UCSF officials said.

Parnassus Heights, they emphasized, will remain a primary research, teaching and patient care site. The UCSF Schools of Dentistry, Medicine, Nursing and Pharmacy and the Graduate Division all will continue to be based at Parnassus Heights.

While the sites, architectural designs,  and exact configuration of the Mission Bay and Parnassus hospitals have yet to be determined, UCSF expects to develop the facilities in highly flexible modules with the goal of providing an optimal environment for patients and families, as well as a highly functional workplace for faculty physicians, scientists, nurses and physicians-in-training.

At Mission Bay, campus leaders envision building UCSF Children’s Hospital, UCSF Women’s Hospital and the first phase of UCSF Cancer Hospital, all located around a central diagnostic and treatment core where imaging, laboratories and procedural rooms will be shared. The plan also calls for building outpatient clinics, parking and faculty offices.

The rationale for the new hospital facilities is based on commitment to providing excellent patient care, meeting increased patient demands for services, and meeting clinical research and medical education needs, UCSF officials stressed.

* UCSF CHILDREN’S HOSPITAL—UCSF Children’s Hospital is ranked the 11th best in the nation, making it the highest ranked pediatric center in Northern California.  Pediatric patients make up about 25 percent of all hospitalized patients treated at UCSF, and the majority of these youngsters come from outside San Francisco.  Location of the UCSF Children’s Hospital at Mission Bay would provide convenient regional access.  Children’s services also are among the most separable from other services on Parnassus and represent the largest single program that can be relocated—freeing up three hospital floors at Parnassus to be used for adult specialty care.

* WOMEN’S HOSPITAL—UCSF’s national reputation in maternal-fetal and neonatal medicine is founded upon close collaborative care involving obstetrics, gynecology, neonatology and pediatric surgery. The co-location of UCSF Children’ s Hospital with a women’s hospital will ensure continued excellence in the care of complex maternal conditions, the diagnosis and treatment of birth defects, and clinical investigation in maternal-fetal surgery.  In addition, co-location of women’s , children’s and cancer services provides further opportunity for UCSF to develop innovative and comprehensive inpatient and outpatient women’s health care that enhances its leading position as a designated National Center of Excellence in Women’s Health.

“The co-location of a women’s hospital with pediatric and cancer services affords unique and exciting opportunities to develop new collaborative models of women-centered inpatient and outpatient care for a range of conditions, including infertility, high-risk pregnancy, gynecologic disorders, continence therapies, and breast and gynecologic cancers,” said Nancy Milliken, MD, director of the UCSF National Center of Excellence in Women’s Health and vice dean of the School of Medicine.

* CANCER HOSPITAL—Building phase one of a cancer specialty hospital at Mission Bay is the first step in a long-range plan to consolidate many of UCSF’s cancer services.  Patients receiving care at children’s and women’s hospitals would greatly benefit from the presence of cancer specialists, and the location of a cancer hospital adjacent to the Helen Diller Family Cancer Research Building now planned for Mission Bay will provide expanded opportunity for the discovery and development of new treatments.  Much of UCSF’s leading research seeks to provide more effective prevention and early detection of cancer.

Also supporting the recommendation for a dedicated hospital for cancer patients is UCSF’s designation as a Comprehensive Cancer Center by the National Cancer Institute and its current ranking by US News and Word Report as one of the 10 best institutions in the country for cancer care.

* CENTER FOR TRANSLATIONAL RESEARCH—Mission Bay would be home to a translational research center, where clinician scientists can test novel therapies in association with scientists who will move to or are already working at the new campus. This linkage with basic science will create a rich environment for new discoveries in treating a range of medical disorders.  “The new center can become a clinical laboratory for the campus that will really leverage post-genomic science,” said Sam Hawgood, MD, chair of the Department of Pediatrics. “Children will increasingly become a focus as genetic risk assessment improves and as interventions, whether lifestyle, behavioral, cell or gene based, are developed. We will be able to use these tools of risk assessment instituting experimental interventions in a futuristic way.”

* SPECIALIZED CARE AT PARNASSUS—The plan makes a strong commitment to the Parnassus campus and continued investment in its clinical, educational, and research facilities.  Adult medicine and surgery specialty programs, such as cardiovascular, neurosciences, and transplant, will be primarily located at Parnassus Heights and supported there by the comprehensive adult emergency department and other services dedicated to complex conditions.  A new pavilion
for inpatient specialized care would be built in a second phase, as the Medical Center can afford it, and in compliance with the campus “space ceiling.”  If new buildings are built, then others of equal size must first come down.

* HUB FOR OUTPATIENT CARE—Mount Zion will continue to serve as the UCSF hub for ambulatory care, specializing in outpatient surgery, women’s health, primary care, dermatology, the Osher Center for Integrative Medicine, dialysis, diagnostic services, select cancer services, and related clinical and translational research.  UCSF officials, in cooperation with the campus and community, will develop plans to augment these programs as well as add more parking and outpatient services in the context of a physical master planning study that was recently completed for the Mount Zion site.

As UCSF moves forward with the recommendations, one major issue to address is financing the new construction.  UCSF Medical Center is largely a self-supporting clinical enterprise, with an expense budget of nearly $1 billion annually. The Medical Center receives about one percent of its budget from state funds.

Other major issues include acquiring new land and completing an environmental review process at Mission Bay and the other campus sites, phasing in programs that provide seamless continuity of care for patients and families, and complying with the space ceiling restrictions on the Parnassus campus.

UCSF officials also will continue discussions with the City regarding potential collaborations with San Francisco General Hospital Medical Center about sharing some services and facilities.

UCSF is working with Catellus Development Corporation to discuss infrastructure improvements to sewer, water and power systems and other issues related to the Mission Bay campus.  A physical master plan depicting the arrangement of uses and the phasing of development at Mission Bay also will be drafted.

Campus planners are currently preparing an Environmental Impact Report (EIR) for the proposed LRDP amendment to ensure compliance with the California Environmental Quality Act. The public will have an opportunity to comment on the analysis contained in that EIR during a 45-day comment period.  Along with the LRDP amendment, the EIR is expected to be presented to the Regents for consideration in early 2005.